AB0219 ASSOCIATION OF DISEASE ACTIVITY AND THE PRESENCE OF BILATERAL CAROTID PLAQUE IN RHEUMATOID ARTHRITIS PATIENTS
Authors: N. Guajardo-Jauregui, D. Á. Galarza-Delgado, J. R. Azpiri-López, I. J. Colunga-Pedraza, A. Cárdenas, A. N. Garza-Cisneros, A. Garcia-Heredia, M. A. Balderas-Palacios, A. B. Rodriguez-Romero
Journal: Annals of the Rheumatic Diseases (2022)

Background Cardiovascular (CV) disease is the major cause of death of RA patients. There is a direct association of systemic inflammation and an accelerated process of atherosclerosis, which is related to higher CV morbimortality (1). Additionally, RA patients with bilateral carotid plaque (CP) had a two-fold risk of developing a CV event compared to patients with unilateral CP (2). Objectives To compare disease activity and other disease characteristics of RA patients with bilateral and unilateral CP. Methods This was a cross-sectional study nested of a RA patients’ cohort. We recruited RA patients who fulfilled the 2010 ACR/EULAR classification criteria. Patients with a previous CV event, another connective tissue disease, or pregnancy were excluded. Disease activity was assessed with DAS28-CRP. A carotid ultrasound was performed to all RA patients, and the presence of CP was considered as a carotid intima media thickness ≥ 1.2 mm or a focal narrowing ≥ 0.5 mm. All RA patients with bilateral CP were included in this study and matched by age (± 5 years), gender, and traditional CV risk factors to RA patients with unilateral CP by a rheumatologist blinded to clinical information. Comparisons were done with Chi-square test for qualitative variables and Student’s T test or Mann-Whitney’s U test for quantitative variables. A p-value &lt; 0.05 was considered statistically significant. Results Mean age of RA patients with bilateral CP was 61.98 ± 6.82 years as compared to 59.70 ± 6.74 years in patients with unilateral CP (p = NS). Demographic characteristics are shown in Figure 1. When comparing disease characteristics, we found a difference in C-reactive protein (CRP) levels, higher in patients with bilateral CP (1.06 mg/dl vs 0.64 mg/dl, p = 0.012), in disease activity assessed with DAS28-CRP as a continuous variable, higher in patients with bilateral CP (3.83 vs 3.05, p = 0.023), and as moderate-high disease activity classification, more prevalent in patients with bilateral CP (70.0% vs 43.3%, p = 0.037) (Table 1). A binary logistic regression, including traditional CV risk factors and disease activity, showed that classification of disease activity in the moderate-high activity category is an independent risk factor for the presence of bilateral CP, OR 3.18, 95% CI 1.033-9.812, p = 0.044. Table 1. Comparison of disease characteristics. Variables RA patients with bilateral CP (n=30) RA patients with unilateral CP (n=30) p-value Disease duration, years, median (IQR) 7.86 (2.97-19.18) 9.02 (6.45-13.66) NS CRP, mg/dl, median (IQR) 1.06 (0.67-1.93) 0.64 (0.43-1.06) 0.012 DAS28-CRP, mean ± SD 3.83 ± 1.27 3.05 ± 1.32 0.023 Moderate-high activity, n (%) 21 (70.0) 13 (43.3) 0.037 Anti-CCP, median (IQR) 15.30 (3.16-196.15) 115.73 (1.60-196.05) NS FR IgG, median (IQR) 5.84 (2.00-17.13) 5.25 (2.00-20.41) NS FR IgM, median (IQR) 156.86 (27.91-200.00) 197.22 (65.71-200.00) NS FR IgA, median (IQR) 85.87 (13.60-200.00) 46.83 (5.33-129.93) NS MTX, n (%) 22 (75.9) 21 (70.0) NS GC, n (%) 16 (55.2) 11 (36.7) NS bDMARD, n (%) 3 (10.3) 6 (20.0) NS NS, no significant; RA, rheumatoid arthritis; CRP, C-reactive protein; anti-CCP, anti-cyclic citrullinated peptide antibodies; RF, rheumatoid factor; MTX, methotrexate; GC, glucocorticoids; bDMARD, biologic disease modifying antirheumatic drugs. Conclusion We found that RA patients with bilateral CP had higher levels of CRP levels, higher DAS28-CRP, and a higher prevalence of being classified in the moderate-high disease activity category, which was independently associated to the presence of bilateral CP. Emphasis should be placed on tight disease control to prevent the development of a major CV events in RA patients. References [1]Skeoch S, Bruce IN. Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat Rev Rheumatol. 2015;11(7):390-400. [2]Evans MR, Escalante A, Battafarano DF, et al. Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis Rheum. 2011;63(5):1211-20. Disclosure of Interests None declared